When considering treatment with weight loss medications, the potential risks of the treatment should be carefully weighed against the potential benefits of continued weight loss for the patient. When deciding to apply drug treatment, you should also pay attention to the following issues.
(1) Timing of medication. Appetite suppressants can be used in obese adults and selected adolescents with obesity. These medications may be used when dietary restriction, exercise, and behavioral therapy are not effective. Appetite suppressants can reduce hunger and cause rapid weight loss.
In comprehensive treatment, if the dose is adjusted or the maximum tolerated dose of appetite suppressant drugs has been used for 3 to 4 weeks without weight loss, such drug treatment should be stopped; if the weight loss continues If it is lowered, it can be used continuously for a period of time.
(2) Duration of medication. Some people believe that appetite suppressants can only be used short-term when diet control and other effects are not good, but others believe that appetite suppressants can be used for a longer period of time to maintain the weight loss effect and prevent weight regain. Combining appetite suppressants with different mechanisms of action can increase the efficacy. For example, combining a small dose of phentermine with fenfluramine can reduce the occurrence of tolerance, enhance the efficacy and reduce adverse reactions, and can be used continuously for about half a year. Fenfluramine can still maintain its efficacy after taking it for 1 year. However, long-term use of indole can lead to hyperinsulinemia, and the effect of long-term treatment is reduced. There is no conclusion yet on how long long-term treatment with appetite suppressant drugs should last. Most patients achieve weight loss within 12 to 24 weeks. After that, they can take the drug intermittently when necessary (such as holidays when food is abundant) to maintain the effect. Appropriate timing of medication can reduce weight fluctuations during obesity treatment. Whether the weight loss effect can be maintained after discontinuation of medication depends on other comprehensive factors.
(3) Combined medication. Most effective weight loss drugs have varying degrees of adverse reactions, which are especially likely to occur when used in large doses. Combining drugs with different mechanisms of action can enhance the efficacy of weight loss, reduce drug dosage, and reduce the incidence of adverse reactions.
For example, the appetite suppressant drugs fenfluramine and phentermine are combined. Due to their different mechanisms of affecting feeding behavior, the former suppresses appetite by enhancing the serotonin system, while the latter suppresses appetite by enhancing the effect of catecholamines. When the two are used together, the dosage of each drug is reduced, but the appetite suppressing effect is enhanced, the weight loss effect is no less than that of either of them when used in sufficient amounts, and the adverse reactions are reduced. Long-term use of maindole can lead to hyperinsulinemia, so the efficacy is reduced during long-term use. If insulin sensitizers such as rosiglitazone and metformin are used together, the adverse effects of maindole can be corrected and the efficacy can be enhanced. The combined use of ephedrine and caffeine, because the latter can block presynaptic membrane adenosine A1 receptors, thereby blocking the inhibition of endogenous norepinephrine release, can enhance the appetite suppressive effect of ephedrine and enhance fat metabolism. Decompose, so combined use can significantly reduce the weight of obese patients. The combination of traditional Chinese medicine weight loss drugs and low-dose appetite suppressants, such as the combination of rhubarb tablets and low-dose fenfluramine, can reduce the incidence of adverse reactions and achieve good weight loss results.
(4) Medication for special groups of people. Adolescents are in the growth and development stage, and their weight loss treatment must undergo strict screening before medication can be used, and strict medication monitoring must be carried out.
Some studies believe that fenfluramine, molindole, growth hormone and low-dose thyroid hormones generally do not affect the growth and development of children with obesity. Appetite suppressing drugs are prohibited during pregnancy and lactation because they may affect fetal development and child growth. Other weight loss drugs are not recommended.
(5) Adverse reactions and drug selection. Most appetite-suppressing drugs and weight-loss drugs that increase energy consumption can produce varying degrees of central nervous system excitability, showing symptoms of irritability, insomnia, euphoria, etc. Susceptible persons and long-term drug users may develop dependence, resulting in abuse. Addicts may experience withdrawal symptoms if they suddenly stop taking drugs. Amphetamines are particularly prone to addiction. Therefore, amphetamines and compound preparations containing amphetamines have been banned from being used for weight loss. Others are also prohibited. Amphetamine appetite suppressants that are prone to dependence, such as benzophetamine and methamphetamine, should only be used as second-line drugs for weight loss. Fenfluramine mainly acts on 5-hydroxytryptamine rather than catecholamines, so the main adverse reactions are sedation, which can cause depression. Large doses can produce stimulant effects. Sudden withdrawal after long-term use can cause severe depression, so it is used This product cannot be administered in an intermittent manner.
Appetite suppressants, central stimulants that increase energy consumption, and thyroxine, etc., can cause dry mouth, dilated pupils, blurred vision, dizziness, tachycardia, elevated blood pressure, arrhythmia, sweating, etc. by stimulating the sympathetic nervous system. Patients with hypertension, angina pectoris, and hyperthyroidism should not use it. The incidence of these adverse reactions is low when using molindole and common doses of fenfluramine. Generally, patients who experience significant weight loss after using the above-mentioned weight-loss drugs may be accompanied by a drop in blood pressure, while susceptible patients may experience an increase in blood pressure and tachycardia.
The use of lipase inhibitors and glucosidase inhibitors may cause gastrointestinal reactions. The former can also affect the absorption of fat-soluble vitamins, so long-term use should be cautious.
(6) Drug interactions. Theoretically, most appetite suppressants can induce the release of norepinephrine and dopamine from adrenergic neurons and prevent the reuptake of these transmitters by nerve endings, causing an increase in blood pressure and affecting the effect of antihypertensive drugs. However, the interference of commonly used amounts of appetite suppressants on the effects of general antihypertensive drugs has no obvious clinical significance. Nonetheless, blood pressure should be monitored weekly during the first 4 to 6 weeks of treatment. The combination of appetite-suppressing drugs and monoamine oxidase inhibitors can cause hypertensive crisis because the latter inhibits the oxidative inactivation of endogenous catecholamines and enhances the effect of this type of transmitter. Therefore, any monoamine oxidase inhibitors that have been used within 2 weeks Appetite suppressants are contraindicated in patients. Taking alkaline drugs at the same time can increase the plasma concentration of appetite suppressants, while urine acidifiers can decrease the plasma concentration of the drugs.
In short, weight loss should be treated with formal and appropriate drug-assisted treatment based on diet, exercise, and behavioral therapy under the guidance of experts. Do not use weight-loss drugs as the main method and do not pay attention to diet, exercise and behavioral changes. This will easily lead to rebound after stopping the drug.
Some people do not have enough understanding of the dangers of obesity and do not take the initiative to treat it, which will eventually lead to various chronic complications and seriously endanger their health. And it is not advisable to blindly pursue physical beauty and lose weight excessively.